Understanding Antidepressant Medications

Depression affects about 121 million people worldwide and is a leading cause of disability, according to the World Health Organization (WHO).

 many people with depression don't realize that they have the condition or that it's treatable,"

Some who suffer from depression don't recognize the symptoms, or they attribute them to lack of sleep or a poor diet. Others realize they are depressed, but they feel too fatigued or ashamed to seek help.

Not all depression requires treatment with medication.

Diagnosing the Disease

Depressed mood

• loss of interest or pleasure in almost all activities
• changes in appetite or weight
• disturbed sleep
• slowed or restless movements
• fatigue, loss of energy
• feelings of worthlessness or excessive guilt
• trouble in thinking, concentrating, or making decisions
• recurring thoughts of death or suicide

Selecting Antidepressants

So how does a physician determine which antidepressant to prescribe? Doctors typically use a patient history and a mental status exam. With this information, the doctor can evaluate symptoms, rule out medical causes of depression, and decide if the criteria are met for major depressive disorder.

"In my opinion, it's best when antidepressant medications are personalized," says Mathis.. "For example, some depressed people have difficulty sleeping. So they would benefit from a more sedating antidepressant at night. Other people with depression sleep too much and would benefit from a more activating antidepressant in the morning."

It's important to communicate how you are feeling so that your physician can evaluate the medication's effectiveness.

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Effectiveness of Antidepressants

Approximately 60 to 70 percent of patients respond to the first antidepressant.

But patients must take regular doses of a prescribed antidepressant for at least 3 to 4 weeks before they are likely to experience the full therapeutic effect. And if patients start to feel better, they should not stop taking the antidepressant.

"Even if you start to feel better, you may be in between episodes," says Mathis. "Depression tends to be chronic and requires everyday treatment just like high blood pressure."

If you get used to an antidepressant and just quit it, you may experience some withdrawal symptoms such as anxiety and irritability. Worst of all, depression may recur.

Patients should continue taking an antidepressant for 6 to 12 months, or in some cases longer, according to the National Institute of Mental Health (NIMH). This gives medication time to be effective and can help prevent a relapse of the depression. Patients should carefully follow their doctor's instructions.

Mathis estimates that about 10 percent of depressions are treatment resistant and won't respond to prescribed antidepressants.

That means that 20 to 30 percent of patients may not respond.

 

 Side Effects

• Headache
• Night sweats
• Nausea
• Agitation
• Sexual problems
• Dry mouth
• Constipation

Side effects are the most common reason people stop taking antidepressants. It's recommended that you don't stop taking your antidepressants or reduce the dosage without talking to your doctor or mental health professional first.

And there are coping strategies for the most common side effects of antidepressants. For a more complete list of side effects and suggested coping strategies, visit www.nimh.nih.gov/health/publications/medications/antidepressant-medications.shtml

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